Computerized Training in Poststroke Aphasia: What About the Long-Term Effects? ARandomized Clinical Trial Rosaria De Luca, MSC,* Bianca Aragona, PsyD,* Simona Leonardi, PsyD,* Michele Torrisi, PsyD,* Bruno Galletti, MD,† Franco Galletti, MD,† Maria Accorinti, MD,* Placido Bramanti, MD,* Maria Cristina De Cola Mstat, MD,* and Rocco Salvatore Calabrò, MD, PhD* Background: Poststroke aphasia is a very disabling disorder, which may affect speech expression, comprehension, and reading or writing. Treatment of aphasia should be initiated as soon as possible after the brain injury; however, the improvement of language functions can occur also in the chronic phase. Materials and Methods: Thirty-two patients were randomly assigned to either an experimental group (17 patients) treated with computerized rehabilitation training (Power-Afa, Maddaloni, Campania, Italy) or a control group (15 patients), submitted to conventional speech therapy. Patients were trained 3 times a week for 8 weeks, (i.e., 24 sessions of 45 minutes each), and assessed at baseline (T0), at the end of each training (T1), and 3 months after the end of the treatment (T2). Results: The experimental group had a signif- icant improvement from T0 to T1 in all the outcomes, whereas for the control group patients such an improvement was significant only concerning Functional Inde- pendence Measure and ideomotor praxis. Notably, the improvements in cognitive and language functions were maintained at 3-month follow-up only in the exper- imental group. Conclusions: The software Power-Afa can be considered a valuable tool in improving the linguistic and cognitive recovery in patients affected by poststroke aphasia in the chronic phase. Further studies with larger samples and longer follow-up periods are needed to confirm such promising findings. Key Words: Nonfluent aphasia—PC-based training—long-term outcomes—cognitive rehabilitation—speech pathology. © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. Introduction Aphasia is a common functional impairment after stroke. Approximately 40%-60% of stroke survivors sustain aphasia at chronic stage, 1 which is associated with their life de- pendence, less social participation, poorer rehabilitation outcomes, and worse quality of life. 2,3 Severity of language deficit depends on many factors, including the location and the extent of the lesion. 4 Indeed, aphasia results both from direct effects of focal damage to eloquent cortical areas and dysfunction of the interconnected remote areas within the language network. 4 In addition, other cognitive deficits and language impairment may coexist in patients with stroke (especially following left hemispheric lesions), and it could be very difficult to assess these deficits in aphasic subjects. 5 Recent data have shown a correlation between aphasia and attention deficit, which are among the most frequent cognitive disorder after stroke, indicating that nonverbal cognitive abilities of aphasics are not fully explained by From the *IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy; and †Otorhinolaryngology Unit, University of Messina, Messina, Italy. Received February 22, 2018; revision received March 21, 2018; accepted April 12, 2018. De Luca and Aragona contributed equally to this work. Address correspondence to Rocco Salvatore Calabrò, MD, PhD, IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113, Contrada Casazza, 98124 Messina, Italy. E-mail: salbro77@tiscali.it. 1052-3057/$ - see front matter © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.04.019 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2018: pp ■■–■■ 1